Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for October 13th, 2010

Child Development

Posted by Dr. Vollmer on October 13, 2010

     Motor, fine and gross, development, language skills, social skills,  cognitive skills and emotional vulnerabilities all unfold to different skill levels and at different rates of change such that a child can seem “odd,” or worse yet, be diagnosed with Asperger’s Disorder, if his development is off track of the majority of other children. Liseth, age six, has an IQ of 170, as determined by the Stanford-Binet IQ test, a test which tends to give children higher IQs than other tests, but even taking that into account, Liseth is a very bright child. She has poor gross motor skills; she has trouble playing catch. She appears not to recognize faces such that other kids that she has seen repeatedly seem unfamiliar to her. However, after a lot of exposure to certain playmates, she begins to recognize them and show them signs of familiarity. As a result, when a child who recognizes Liseth, but Liseth does not recognize him, there is an odd interchange. It is as if there is a facial recognition part of the brain which is either undeveloped or nonexistent in Liseth’s neuroanatomical structure.

    Liseth is impulsive and inattentive to things she does not care about. She loves learning about architecture, so she spends a great deal of time on the internet looking at building design. On the other hand, when it comes to waiting her turn to play games, she struggles with the wait. She does not pay attention to follow instructions such that she will be in her own world while a teacher is telling the class to move on to the next subject. As such, many of her teachers have experienced her as “odd”.

  Liseth also suffers from anxiety; she thinks about catastrophic events and she worries that something bad will happen to her parents. She has trouble sleeping because she is preoccupied with negative and scary thoughts. She speaks about her gloomy thoughts in an articulate manner and she has since she was two. Liseth’s verbal skills far exceed her peers.

   Liseth’s mother, Ella, was just like Liseth when she was a child, except that no one thought Ella was “odd”. Ella grew up before the diagnosis of Asperger’s floated around in our universe. Ella explained to me that everyone thought she was “insanely bright” and so they cut her a lot of slack for her “atypical” behaviors.

   My impression is that Liseth is outside of the bell-shaped curve; both in her basic abilities and in her rate of development. In some areas, like her language skills,  she is far ahead of her peers; in other areas, such as her gross motor skills, her developmental delay is significant. Since her skills are not in line with her peers, both her excellent language skills and her poor motor skills create a social liability. Poor facial recognition hurts her too, in the social arena that is. As Liseth develops, as her peers develop, there is likely to be a leveling off, such that the discrepancies in skill level will be smaller. Still, this remains a hypothesis, a guess, which only time will answer. Time is a large variable in development. The rate of change for each child is different, making the diagnosis of Asperger’s Disorder, at least in some children, premature. Until we have a better understanding of  child development, we have to respect that maturation is a dynamic process; one that humbles clinicians.

Posted in Child Development, Musings | 9 Comments »

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